What is already known on this subject? It has been established that the public is often confused by the threat that a potential pandemic virus poses and that they are unsure of what information related to the disease they can trust. Government health agencies often walk the line of minimizing the threat to prevent panic, but simultaneously emphasize the importance of action (vaccination) to prevent a worldwide pandemic. What does this study add? Beyond the physical threat of a pandemic, a significant psychological toll may occur for certain individuals. Anxiety regarding H1N1 is heightened amongst those who cannot tolerate uncertainty. Appraisals of threat, control, and the use of emotion-focused coping mediate the above relationship.

Swine flu (H1N1) reached pandemic proportions in 2009, yet ambivalence was met concerning intentions to be vaccinated. The present investigation determined predictors of perceived H1N1 contraction risk and vaccination intentions among Canadian adults (N = 1,027) responding to an online questionnaire. The relatively low rate of vaccination intent (30.12%, and 34.99% being unsure of their intent) was related to a sense of invulnerability regarding illness contraction and symptom severity. Most individuals were skeptical that H1N1 would be widespread, believing that less than 10% of the population would contract H1N1. Yet, they also indicated that their attitudes would change once a single person they knew contracted the illness. Also, worry regarding H1N1 was related to self-contraction risk and odds of individuals seeking vaccination. Moreover, vaccination intent was related to the perception that the threat was not particularly great, mistrust of the media to provide accurate information regarding H1N1, and whether individuals endorsed problem-focused versus avoidant coping strategies. Given the role media plays in public perceptions related to a health crisis, trust in this outlet and credibility regarding the threat are necessary for adherence to recommended measures to minimize health risk.

H1N1 reached pandemic proportions in 2009, yet considerable ambivalence was apparent concerning the threat presented and the inclination to be vaccinated. The present investigation assessed several factors, notably appraisals of the threat, intolerance of uncertainty, and familiarity with the virus, that might contribute to reactions to a potential future viral threat. Canadian adults (N = 316) provided with several scenarios regarding viral threats reported moderate feelings of anxiety, irrespective of whether the viral threat was one that was familiar versus one that was entirely unfamiliar to them (H1N1 recurrence, H5N1, a fictitious virus: D3N4). Participants appraised the stressfulness of the threats to be moderate and believed that they would have control in this situation. However, among individuals with high intolerance of uncertainty, the viral threat was accompanied by high levels of anxiety, which was mediated by aspects of appraisals, particularly control and stressfulness. In addition, among those individuals that generally appraised ambiguous life events as being stressful, the viral threat appraisals were accompanied by still greater anxiety. Given the limited response to potential viral threats, these results raise concerns that the public may be hesitant to heed recommendations should another pandemic occur.

Background: Canada is facing an urgent challenge to reduce the harms associated with opioids: from January 2016 to December of 2018, more than 11,500 individuals lost their lives due to opioid related harms. This review examines responses to the opioid crisis thus far, the lessons learned from these initiatives and the knowledge gaps that still need to be addressed across the four pillar model adopted by the CDSS. Methods: A search of peer-reviewed literature was conducted in PubMed and PsycNet, and grey literature was retrieved from reputable substance use and health organizations to determine responses to the opioid crisis and related outcomes between 2013 and 2019. Findings related to actions, outcomes and unintended consequences across the categories of prevention, treatment, harm reduction, enforcement and the evidence base were included and synthesized into a narrative review on lessons learned. Results: The opioid crisis is a result of multiple, complex interrelated factors. Many physicians may not feel competent to appropriately treat pain and/or addiction. Pushes for opioid deprescribing have resulted in some individuals using illicit opioids as treatment. A range of effective and accessible pharmacological and psychological treatments are still required. When regulations are barriers, unsanctioned actions, such as overdose prevention sites, may be enacted by individuals to respond to urgent public health needs. A nimble response with evolving enforcement perspectives can aid individuals experiencing harms from opioid use. Conclusions: There is no one size fits all response to this crisis, and consideration should be given to the unique needs of different communities and populations, as well as the broader impact of harms on families, communities, and society. A situation so multifaceted requires both immediate and long-term strategies implemented concurrently in order to address the differing and ongoing needs of Canadians experiencing opioid harms. The expertise of individuals and families affected by the opioid crisis must be included in consultations and decisions related to different strategies, to ensure responses are not stigmatizing, that they will be effective and acceptable and that unintended consequences are quickly recognized and mitigated.

Background Guidelines recommend that individuals with opioid use disorder (OUD) receive pharmacological and psychosocial interventions; however, the most appropriate psychosocial intervention is not known. In collaboration with people with lived experience, clinicians, and policy makers, we sought to assess the relative benefits of psychosocial interventions as an adjunct to opioid agonist therapy (OAT) among persons with OUD. Methods A review protocol was registered a priori (CRD42018090761), and a comprehensive search for randomized controlled trials (RCT) was conducted from database inception to June 2020 in MEDLINE, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials. Established methods for study selection and data extraction were used. Primary outcomes were treatment retention and opioid use (measured by urinalysis for opioid use and opioid abstinence outcomes). Odds ratios were estimated using network meta-analyses (NMA) as appropriate based on available evidence, and in remaining cases alternative approaches to synthesis were used. Results Seventy-two RCTs met the inclusion criteria. Risk of bias evaluations commonly identified study limitations and poor reporting with regard to methods used for allocation concealment and selective outcome reporting. Due to inconsistency in reporting of outcome measures, only 48 RCTs (20 unique interventions, 5,404 participants) were included for NMA of treatment retention, where statistically significant differences were found when psychosocial interventions were used as an adjunct to OAT as compared to OAT-only. The addition of rewards-based interventions such as contingency management (alone or with community reinforcement approach) to OAT was superior to OAT-only. Few statistically significant differences between psychosocial interventions were identified among any other pairwise comparisons. Heterogeneity in reporting formats precluded an NMA for opioid use. A structured synthesis was undertaken for the remaining outcomes which included opioid use (n = 18 studies) and opioid abstinence (n = 35 studies), where the majority of studies found no significant difference between OAT plus psychosocial interventions as compared to OAT-only. Conclusions This systematic review offers a comprehensive synthesis of the available evidence and the limitations of current trials of psychosocial interventions applied as an adjunct to OAT for OUD. Clinicians and health services may wish to consider integrating contingency management in addition to OAT for OUD in their settings to improve treatment retention. Aside from treatment retention, few differences were consistently found between psychosocial interventions adjunctive to OAT and OAT-only. There is a need for high-quality RCTs to establish more definitive conclusions. Trial registration PROSPERO registration CRD42018090761.